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Dispenser Conversion Evaluation Form <br />Distributor: <br />Sales Person: <br />Existing Dispenser <br />MANUFACTURER <br />SPECIFIC MODEL NUMBER <br />P.O. # <br />NEW Dispenser <br />MANUFACTURER C 1 fca cS-DQR hS L <br />?�MR <br />.. 46 <br />ZEE- <br />Existing UDC Sump <br />Is it a Bravo UDC? ❑ or Make/Model <br />Shallow pan or Deep Sump? <br />Water splash lip opening (I.D.): Length Width 1 <br /># of existing Anchor Bolts for concrete pad / island: <br />Does the existing UDC have a water splash lip? _ <br />THE FOLLOWING APPLIES TO THE STATE OF CALIFORNIA ONLY <br />DISPENSER / HYDRAULIC CABINET <br />wATER:SPLASH LIP <br />Does conduit exist within 2" of the inner opening? ( IF YES, IMAGES ARE REQUIRED ) <br />;2' Does conduit exist outside of the UDC water splash lip? (IF YES, IMAGES ARE REQUIRED ) <br />FOR ASSISTANCE, CALL 800 -AT -BRAVO <br />FAX TO 323-888-4123 OR EMAIL TO YOUR SALES REPRESENTATIVE <br />12A <br />hBIRWO WWW.SBRAVO.COM made Certified <br />In US800-AT-BRAVO mw'sBwitr.'enwgrcc PROBLEM SOLVED MEM(3ER <br />